Tuesday, February 07, 2006

Pregnancy and Depression

This is "old" news now, but a recent study published in the Journal of the American Medical Association [1 Feb 2006; 295(5): 499-507] found that pregnancy did not protect women from depression. Apparently, it was was once "common belief that the hormonal changes associated with pregnancy provide a protective effect against depression." The authors note, "Pregnancy has historically been described as a time of emotional well-being, providing 'protection' against psychiatric disorder. However, systematic data to support this impression are sparse." The intention of the study was to test whether women receiving maintenance antidepressive treatment could successfully discontinue those medications during pregnancy without relapse or not, indicating whether pregnancy really does have a protective effect against depression.

201 pregnant women were enrolled in the study who had a previous history of major depression, were less than 16 weeks along, had normal thyroid function, and were currently receiving antidepressant treatment. Women who were actively suicidal, had certain mental disorders (schizophrenia, for example), had positive drug tests, or had medical conditions associated with depressive symptoms were excluded. The women were split into two groups who either continued or discontinued their medications. The women were not randomized, but were informed about the nature of the study and allowed to choose which path to take.

Of those who stopped taking their medicines, 68% relapsed into major despression during the study. Curiously, 26% of women who continued taking their meds also experienced depression. 61% of those who discontinued or decreased their antidepressant medications reintroduced the drug therapy during pregnancy. The authors note a few limitations of their work (such as the non-randomized design), but conclude that pregnancy does not have a protective effect against depression.

It's hard to make a decision about taking antidepressants during pregnancy. If you are depressed and anxious, it could have detrimental effects on your unborn baby, but so could the effects of the meds that help with depression. What to do?